Audiological Diagnostic Assessment Protocol:

1. Detailed history should include but is not limited to:

  • Parental report of auditory and visual behaviors
  •  Motor development
  • Family history of hearing loss
  • History of middle ear pathologies
  • Parental concerns
  • Prenatal, birth, and neonatal history
  • Medical history including: Syndromes or other inheritable conditions, craniofacial abnormalities, kidney issues, conditions of limbs/digits, pigmentation issues, exposure to ototoxic medications

2. Otoscopy:

Visual inspection for obvious structural abnormalities of the pinna and ear canal

3. Evoked Otoacoustic Emissions:

  • Transients or Distortion Products
  • TEOAE click stimuli: One level (e.g., 80-85 dB pSPL) should be completed.
  • DPOAE stimuli: Use L1/L2 of 65/55 dB SPL
  • Pass criterion: Emission of 6 dB signal to noise ratio for at least three frequencies in each ear. At least one frequency should be located between 2000 and 3000 Hz A second frequency should be located between 3000 and 4000 Hz
  • The third point could be at any other frequency between 1000 Hz and 6000 Hz

4. Acoustic Immitance Testing:

  • Tympanometry - 660 Hz or higher probe tone in children under 6-18 months
  • 220Hz is acceptable in children 18-36 months

5. Acoustic Reflex

  • Ipsilateral middle ear muscle reflex thresholds for 500, 1000, 2000, and 4000
  • Pass Criterion: Type A tympanogram and present acoustic reflexes

6. Behavioral Observation Audiometry (BOA)

  • In soundfield or with earphones using calibrated stimuli. Insert earphones are recommended if possible.
  • Pass criterion: minimal and/or startle response at 65 dB.

7.  Visual Reinforcement Audiometry (VRA): (if appropriate due to child's developmental level)

  • Stimuli should be speech and also frequency specific tones between 250- 6000 Hz. 
  • Insert earphones are preferable; sound field may be necessary with some children who will not tolerate earphones.
  • Pass Criterion: 20 dB to speech and threshold responses at 500, 1000, 2000, and 4000 Hz tones.

8.  At least one ABR is recommended as part of a complete audiology diagnostic evaluation for children younger than 3 years old for confirmation of permanent hearing loss. (The same procedures as outlined in newborn-6 months for recommended ABR procedures apply.)